| NPI | 1639693849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180015775) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 107440) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2025-07-16 |